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Dochd:372433279 Page 1

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Assassination Records Review Board
Final Determination Notification

AGENCY : HSCA
RECORD NUMBER : 180-10068-10363
RECORD SERIES :. STAFF PAYROLL RECORDS
AGENCY FILE NUMBER : . |

December 8, 1995

Status of Document: Postponed in Part

Number of releases of previously postponed information: 11 |

Reason for Board Action: The Review Board's decision was premised on several factors
including: (a) the significant historical interest in the document in question; (b) the —
absence of evidence that the release of the information would cause harm to the United
States or to any individual. |

Number of Postponements: 9

Postponements: All the postponements in this document represent Social Security numbers.
Reason for Board Action: The text is redacted because the public disclosure of the redaction could
reasonably be expected to constitute an unwarranted invasion of personal privacy, and that invasion of

privacy would be so substantial that it outweighs the public interest.

Substitute Language: SSN

~ Date of Next Review: 2017

- Board Review Completed: 10/24/95.


Date:08/20/93
- Page:1
JFK ASSASSINATION SYSTEM .

. IDENTIFICATION FORM

| AGENCY INFORMATION
AGENCY : HSCA |
RECORD NUMBER : 180-10068-10363

RECORDS SERIES
STAFF PAYROLL RECORDS

ee

AGENCY FILE NUMBER :

_ DOCUMENT INFORMATION

ORIGINATOR HSCA
FROM
TO

TITLE

01/01/77
11

DATE
PAGES

. SUBJECTS
HSCA, ADMINSTRATION
GRIMES, MARY SUSAN

DOCUMENT TYPE : PRINTED FORM

CLASSIFICATION : U

RESTRICTIONS ;: 3
CURRENT STATUS : P a
DATE OF LAST REVIEW : 07/07/93

OPENING CRITERIA

COMMENTS

Box #:1.

{R] ~- ITEM IS RESTRICTED

‘NW 98326
Docld:372743329 Page #

PAYROLL AUTHORIZATION FORM

A Us. HOUSE OF -REPRESENTATIVES(_)° (Any erasures, corrections, or changes:
oe Washington, D.C..20515

(Please Use Typewriter:
or Ballpoint Pen)

authorizing official.)

To the Clerk of the House of Representatives:

| hereby authorize the following payroll action:

Employee Name (First-Middle-Last). =. 3 = Effective Date

12/31/78 a

Mary gusan Grimes ..-

212-56-6718 1 Appointment :
) Salary Adjustment
C) Title Change

SGI Termination (At close of business on effective date}

Employing Office or Committee/Subcommitiee

Age aesdinations C1 Leave without pay (Beginning with effective date above and ending

close of business... = = = )
: Specify Date

(If type of action is an Appointment, Salary Adjustment, or Title Change, complete appropriate information below.)

Position Title Gross Annual Salary*

._ * If employee is a civil service annuitant (includes U.S. House of Representatives}, the gross annual salary shown should include the ‘annuity received by the employee

plus the salary received from the employing office.

(If Committee Employee, complete appropriate item below.)

1. 0 Standing Committee: Staff—Li Ciericai or 0 Professional.

2. Special (Investigative staff of Standing Committee) or Select Committee: Authority—H. Re@5& __of Sth Congress.

3. C1 Joint Committee.

(If Employee of an Officer of the House, complete item below.)

Position Number ~__If applicable, Level_

| certify that this authorization is not..in violation of 5 U.S.C. 3110(b), prohibiting the employment of
relatives.

Date. Janueags 2 WI
. (Signature of Authorizing Official)
LOUIS STGXES
“(iFappropriate, signature of Subcommittee Chairman or Ranking Minority Member). Type or printnome-of Authorizing Oficial), ~=—=SOSt*=~“S*~=<S*CS
CRALTRMAN

All appointments and salary adjustments for employees under: the House Classification Act and for Committee em----
'. ployees, except those of the Committee on Appropriations, the Committee on the Budget, and the Joint Committees, must.
_.be approved by the Committee on House Administration. :

Chairman, Committee on House Administration

APPROVED:

Office. of Finance use only:
Office Code

Monthly Annuity $

ae Se aad pe “Copy for: Initiating Office-or Gommittee.% oe.f ee we

NW 88326 ee —
ocld:32243329 Page 3 : ; et! !

on this form must be initialed by the

; Employee Social Security Number | Type of Action =

a
WMkubl ue AG Se es

So ea ta wee
AES i ee a tthe

FO Erste EROS CeCe UW Res Pr OES Bk TOR RCE LEED Y POMEL SF RO SEDO CDESC ONCE IOT TSE. Tin PS TT OE CTT
\

So ptt

att

ws Mee Lari Adee tess Wien tat a ate et at te Nae tailed

+

a

- (If Committee Employee, complete appropriate item below.) “ S
1. oO Standing Committee: Staff—O Clerical or 0 Professional:
2. 1) Special-{Investigative staff of Standing: Committee). or Select Committee: ‘Authority—H. Resse | _o PSE Congress. ;
3. 0 Joint Committee. .

_ (If Employee of an Officer of the House, complete item below.)
Position Number_____________.___If applicable, Level. Step__

PAYROLL AUTHORIZATION Fe-"4= -
S

U:S. HOUSE OF - REPRESENTATIVE
“. - @ Washington, D.C. 20515

(Any erasures, corrections, or changes.
- 9n this form must be initialed by the |
~ authorizing official.).

(Please Use Typewriter:
or Ballpoint Pen)’ ~

To the Clerk of the House of Representatives:

| hereby authorize the following, payroll action: mo

_-Employee Name (First- -iMliddle-Last) ; 7 —_ To __ Effective D: Date
Mary Susan Grimes Novenber i, 2878

Employee Social Security Number © mi : — | “Type of Action

=C] Appointment
0 Salary Adjustment
“1G Title Change
( Termination (At close of business on effective date)

1) Leave without pay (Beginning with effective date above and. ending |: ° a
close of business

Specify Date

(If type of action is. an Appointment, Salary Adjustment, or Title'Change,-complete appropriate information below.) -

—_ Position Title Gross Annual Salary* _ a

Reeearcher . 34,268.90 | ‘

..* If employee jis a civil service annuitant (includes U:S. House of Representatives), the gross annual salary shown’ should include the annuity received by the employee
plus the salary received from the employing office.

| certify” that this authorization. is not in violation oof 5. U.S.C. 3110(b), Prohibiting theemployment: of
relatives. - — Fe ;

Boverber 8 a eo
Date. ee. inh ie
: : . a : (Signature of Authorizing Official) 5
we LOUIS STORES
Af cpproprai, “Signature of Subcommittée Chairman or Ranking Minority Member) “7 oT Type or print nome of Authorizing Official), SSC 4
Chairman

Ao

All appointments .and. salary adjustments for employees under the House: Classification Act and for Committee em-

ployees, except those of the Committee on Appropriations, the Committee on the Budget, and the Joint Committees, must”
be approved. byt the Committee on House Administration.

APPROVED:

Chairman, Committee on House Administration .

Office of Finance use only:
Office ete


Certificate of Relationship/Nonrelationship to
Any Current Member of Congress

78

I certify that I do not have any of the following relationships to any
current Member of Congress.

father nephew sister-in-law
mother niece stepfather

- son husband stepmother
daughter wife stepson
brother father-in-law stepdaughter
sister mother-in-law '  stepbrother —
uncle '  gon-in-law stepsister
aunt daughter-in-law half-brother
first cousin brother-in-law. half-sister

fli certify that Iam the _.._SES Cf the

(Relationship)

Honorable
: (Name of Member to whom related)

(Employee)

GPO 16~-78695-3

2 te ad


i pce us’. ce “pISTRICT - UNEMPLOYMENT - COMPENSATION BOARD

Rete qfF8

: Fraployee - —_ 6 abe
; Bogle Se rity No. __212-56-6718. a ae Name

| oe During the CALENDAR WEEK beginning SUND O¢ A ae

Ie ‘tion for that week were 563.64... 7

2, Hig gross earnings payable before deductions, which include tips, ‘eash value of meals, lodgings, and all other remunera- s

. sxroooutroooeooxapopoaaaioaAKKEARRAEEHOOPOREERAOADAREEN CO

NW 88326
_ Docld:32243329 Page. &.

a " Pealson’ for separation -— employee. _ works: ¢ ‘one._day.-a. heck until ond-of-Devenber=-——

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‘4, Simploy e's Name. Se ee as ee _—- che eee a

- LOW EARNINGS REPORT—To be completed by the employer and delivered oe we Le
to the claimant at his request. satis 7

eee a Sap ey ee ae ae ome om

AY October 22

aero ein ee on a a ae na aan

_ this employee worked (1. FULL. TIME PART TIME o.°

2.. His. gross earnings payable before deductions, which include tps, « cash value of meals, ste .

SATURDAY __October 28 _ ic (NOT your payroll ‘week, i different), Say

io

3. Original employment date 11.

Select Committee. .on Assassinations
:, Employer's Name ——-~—-~----

and U.S touse- Of Bep resentatives .

fdaress nanan Bann a an a ee nnn

Inne Pot ae LL (Lie Tom Howarth. 2252980...

Bien ena "Person * who may , be » eoatactad) |

re emer e mrnee a eo ane fae A te A ee ae ne ht RL

oer wines ee wenn mn einen a er teen uaa ae a me A eee olin ese

‘(Signature ure of oii voniensl) a 3-55704

om LER accepted 2 as san hadietonat {

“Date of Claim Be

fo: ace a oe! ‘DISTRICT U NEMPLOYMENT COMPENSATION BOARD -
pee WTB - LOW EARNINGS REPORT—To be completed by the employer and | delivered
i _ _ _ -\ to the ciaimant at his request. ~ . a :
SEE ey No. 21275676718 Name _Mary.. Susan Grimes. ae af
_.October 15.) © _ ; gee
;. During the CALENDAR WEEK beginning SUNDAY wane and ending -
” SATURDAY ___ October 21 Ws (NOT your payroll week, | if ' different), ” mo - ons

this employee worked (1. FULL TIME cX PART TIME

7 tion for that week were 5.63.64. 2. a oe ; . oe mo

Oct 18 Pe Last day fone 2EE BB wt

Select Committee ¢ on Assassinations

U.S. ae of Representatives ee
ur L CoCr LEM PTE.. “tom Howarth 2250 ~2980 |
avey — a ae _ : (Person who. may be contacted). i - ; (Phone "No. > - J

J-55701 ; (DateY

OFF ICE USE ONLY

1c] LER accepted 2 as an | Additional Chain (Carnings exceed eligibility amount. ), . a

ed Po en nn ened ee

‘Date of Claim _ ae Office ‘Representative

PAYROLL AUTHORIZATION FORM Po CE 4

(Please Use Typewriter - ve ~UWws.: ‘HOUSE OF. REPRESENTATIVES (Any erasures, corrections, of changes.

aenet a, os : co. + On. this form must be- initialed by the
or Ballpoint Pen) Washington, D.C-20515° authorizing official.) :

&

To the Clerk of the House of Representatives:

| hereby authorize the following payroll action: :

Employee Name (First-Middie-Last).  - --—=«| =~ Effective Date

Mecy Susan Grimes . a |. 9f45778
Employee Social Security Number = Je _Type of Action

21 2—56—_47 18 | O Appointment

; _- O Salary Adjustment, . © %
- Employing Office or Committee/Subcommittee ©. ~~ |.C Title Change
. _ Gk Termination (Ai close of business on effective date) 8
Assassinations 1 Leave without pay (Beginning with effective date above and ending |. :
; close of business ;

Specify Date ;

_ (If type. of action-is-an Appointment, Salary Adjustment, or Title Change, complete appropriate information below.) :°

Position Title fos : Gross Annual Salary*

. *AE emoloyee is a civil service annuitant {includes UsS¢ House. of Representatives the > gross ‘annual: ‘salary shown. should include the* annuity received! by the employee *
plus the salary received from the employing office.

(If Committee Employee, complete appropriate item below.) - ; 4 eo
- \

1. O Standing Committee: Staff—O Clerical or 0 Professional. : = \

2. Ed Special (Investigative staff of Standing Committee) or Select Committee: Authority—H. Res._236_of- 22% ICongress 2 \

3. 0 Joint.Committee. 4
(If Employee of an Officer of the House; complete item. below.) 4 a

3

Position Number___._- wate eee. lf applicable, Level. Step___ .

. | certify. that ‘this. authorization | is -not~in violation. of -5-U. s. C.. 3110(b), prohibiting the employment of a
relatives. e
Dote.___ September 24 000 1978 a

Gignoture “of Authorizing Official) 2A
LOUIS STOKES, GHATBEAR &

N

» °° - All appointments: and salary ‘adjustments for employees under the House Classification Act and-for Committee em- |
. ployees, except those: of the Committee on Appropriations; the Committee: on-the> Budget, and -the’Joint Committéés, must -
be approved by the Committee on House Administration. - : .

——

APPROVED:

. . my vat ae
. : _ tle oie
PE OTO CEL SNORE OPCATEIE: LID ct act Leas

Office of Finance use only:

Office Code

sot lang eect
Webi! eck ae eee cies

are -.4t . . a i rt er ett er tt mentee ie sentient”

: wee jones ee rb ne ee eee

~ PAYROLL- AUTHORIZATION: FORM = ek ae re
~ “U s. ‘HOUSE: OF REPRESENTATIVES:
"Washington, D.C. 20515 *. +

“e(Any erasures:- ‘corrections: :or :changes.:..*.
..-- On -this form must be:: initialed . -by the; .
~ authorizing official.)

t

: «Please Use’ Typewriters:
‘a a or Ballpoint Peni): ®
|
}

To the Clerk of the House of Representatives: © °° <0 ns

| hereby authorize the following-payroll action:

oe ‘Employee: Name (First-Middle-Last) a ee a “Effective Dates
Hary Susan Grimes
~ Employee $ Social Security Number: = = a [ee z Zz ; a | - Type of Action a
212 56 6718 1 Appointment,
Employing Office or Committee. oe} a | Selary Adjustment

‘. Assassinations : oh J] Termination (At close of bisiness on: effective date).

~ (IFtype: of action:is an-Appointment or Salary Adjustment;-complete the following-information,) © 2c

i Position Title Bross Annual Salary

$21,008

- (If Committee Employee, -complete appropriate item -below.):..
ok [J Standing Committee: Staff—[7] Clerical or [-}'Professional. 2°
7 a ~ 2.§8) Special or Select Committee: Authority—H: Res... $82 of SSER Congress. ~

3 OO. Joint Committee. :

L (If Employee of an Officer of the House; completevitern:below.) vets 02% Oa s a
Position Number 21 2.2-.lF applicable, Levels Steps.

Loe A cont that: this. authorization. is “not-sin~ violation. of 5. :U.S.C>: 3110(b), -prohibiting: the: ‘employment: offer

relatives. vemevseweel oe

TT i a ee er PL

Type or print name of Authorizing Official)

a
_o__ Chatrwan

yf - (Title-If Member, District and State)

rr rs i a sn ee i ee Stestenientenstnatadantentenianietententenientantetaetantalmieiestesterleieteertederioaiecion Pras

All -appointments-and-salary ‘adjustments for employee's. under-the. House’-Classification ‘Act -and for: Committee ‘em-'

: C
; -_pleyees, except::those-ofzthe.Committée on: Appropriations,’ the Commiftee:.on the: Budget, ‘and the JoiAt ‘Committees; must \
~ be: approved. by. the: ‘Committee on House Administration. °2. ‘se. 5 - toe c moe \

\

- APPROVED:

Office of Finance use only: .
Office Code.

Copy -for initiating Office or Committee 92 jc ei ee


a ployees,. excepti:those of the Committee on Appropriations: t ‘the Committee ‘on: the Budget, ‘and. tthe: Joint’ “Committees, must:
po

PAYROLL AUTHORIZATION FORM

(Please Use Typewriter a U S. HOUSE OF: REPRESENTATIVES . =" (Any erasures, corrections, or changes :-.
_or Ballpoint Pen) ==. Washington, D.C. 20515 2 Se nad be initiated by the

To the Clerk of the House of Representatives:

| hereby authorize the following payroll action:

Employee Name (First-Middle-Last). oe 8 vs, _ a ‘Effective Date oe
_Hary Susan Grimes | ATT
“Employee Social Security Number

212 56 6718

ie ion

L] Appointment
“Employing Office or Committee =. 7 8 Sclary Adjustment

Assassinations . . | Termination (At close-of business on effective date) .

- (If type of action is an Appointment or Salary Adjustment, complete the following information )

Position Title

tye oy Sia oper
2 Sans Shac lake soe alse igre ta ado STATE an Pies eh Ba ER, FATS sete cath eg!

“Gross Annual Salary - _

57%,

TaN R EOE en EDT NTI Tn We ONY

$48,600

N

(If Committee Employee,.complete appropriate item below.)

-1. LJ Standing Committee: Staff-[_] Clerical or [5] Professional.

2. [3 Special or Select Committee: Authority—H. Res..409 __ _of- 95th

ISTH Congress:
3.C] Joint Committee.
(If Employee of an Officer of the House, complete item below.) |
Pésition, Number. If applicable, Level_- Step__-

- Lecertify: that: this authorization is not in violation of 5” USC » 311 0(b), prohibiting the employment of as
relatives. ; aye

eee ee ye

a of Authorizing Official) :

a “Louis Stokes

(Type or print name of Authorizing Official) -

uf ° Chai rman

all appointments and salary adjustments for employees under. the House . Classification Actand for Committee em-

‘be. approved by the Committee on House Administration. :

APPROVED:

Chairman, Committee’ on: + House Administration Be

Office of Finance use only: os : 4
Office Code a
. Copy for. imitiating Office or Committee Se 4
| NW 88326 PO a
| Docld:32243329 Page 9 : Pegs


PAYROLL AUTHORIZATION: FORM. er re

wee (Please: Use:Typewriter « -o-* U. S:: HOUSE: OF.. REPRESENTATIVES: - ooo. co(Any erasures,. corrections,-or- changes. +.
: ws Washington, D. C.20515 . . On this form. must, be, initialed by. the.

or Ballpoint Pen) authorizing official.) ©

To the Clerk of the.House of Representatives:

| hereby authorize the following payroll action:

“Employee Name (Fitst- “Middle- -Last) ote ee Effective Date.

Har ry ) Susan Grimes

Employee. Social Security Number: Type of Action

“22-56-6718

(] Appointment

Employing Office or Committee - - ae) (Salary Adjustment .

. Select Comal ttee on Assassinations {] Termination (At close of business ¢ on effective date} -

(If type of action is an Appointment or Salary Adjustment, complete the following information.) .:

Position Title . om Gross Annual Salary — . 7

$12,915.” _

(If Committee Employee, complete. appropriate item below:}:25"" soe oy

1. [-] Standing Committee: Staff—[_] Clerical or {J Professional...» -

2: [8] Special or Select Committee: Authority—H: Res. mas of __95 Congress.» 2"

3. [_] Joint Committee:

(If Employee of an Officer of the House, complete item below.) «0-5 8 co teaters

Position Number ane _. if applicable, Level _-

~~ --aiH aa ee,

-¢becertify,that. this. authorization. is: not: in: violation -of. 5 -U.S.C. -3110(b); -prohibiting- the..émployment..of:.<-

relatives.

(Signature of Authorizing Official)

Henry B. Gonzalez

(Type or print name of Authorizing Official): - -
| Chairman

ae yy. All appointments:and-salary: adjustments-for employees under the.House-Classification-Act*and: for ‘Committee :em-7:
ployees; except ,thoseof the :‘Committee.on-Appropriations;the- Committee: ‘on--the; Budget; and: the.Joint: Committees,«n musts:
-be approved by the Committee: on-House:Administration. © ot che te fe ee ee ak ae 2a

_ ARPROVED:

Chairman, Committee on House Administration -,

Office-of Finance use onlyz. 00 oe
_ Office Code

Copy for. Initiating. Office or Committee:

tek Uh i yan teae Slo Meet gt

ee se a en ee ee
| 88326 | DO _.

1d:32243329 Page 10 ; “eens ;

oti

5 =
3 +
one
‘ %

° a a _ i !
~- (If type of action is an Appointment or Salary Adjustment, complete the following information.). oe a |

| PAYROLL AUTHORIZATION FORM. . . oe :
I ~ (Please Use Typewriter” te Ne U. Se HOUSE OF REPRESENTATIVES ~~ (Any erasures, corrections, or changes -
i this form must be initialed by the
, | or Ballpoint Pen) | ~ Washington, D.C. 20515. | “authorizing official.) - |
im
| ~ To the Clerk of the House of Representatives: == ee
- y . ° . . . ‘
| hereby authorize the following payroll-action: — oo - \
Employee Name (First-Middle-Last), «|= ~=Ss*s*é=«~S*é«@éfective Date fe
= ; —_ - To | i
Mary Susan Grimes. — 4 WaT? Co <

CL) Appointment . ~

Employing office‘ Committee ~ =i: Solary Adjustment © SS

“Select Commi thee an A issassina tions mo L] Termination (At close of business « on effective date)

Position Title a ae y _

wi

[
. (If Committee Employee, complete appropriate item below.) a re |
+ . . . . . i

1. E) Standing Committee: Staff] Clerical or [_] Professional:

-_ 7 7 se aseh SO wy
« 2. [7] Special or Select‘Committee: Authority —H- Res... of! "*""_ Congress. . re ,

‘~3. [-] Joint Committee. Be . Oe sO -

(If Employee of an Officer of the House, complete item below,). / _ |

Position Number : if epplicable, Level _

a

| -certify.. that this authorization is not- in. violation of 5 US.C, -3110(b), prohibiting + the employment of -
relatives. o ~ an . . ~

|

~= Sep a :
. |

|

|

. TSignoture of Authorizing Official)
~. : , 48 » By oo
- No ‘ - Hanpy 3. Serzvaler

(Type or ‘print name of Authorizing Official)

— Chat rien , , ‘ °

oloyees; except those of: the-Gommittee. on Appropriations, the: Committee- ‘on the. Budget, ‘and the Joint Committees, must -
-‘be-approved by. the ‘Committee on House Administration: :
re

a  APPROVED:._

Office of Finance use only:

Office Code.

|
|
all appointments and salary adjustments for employees under the: House: Classification Act and for: Committee.em- 7
I
|
|

88326 : Doe

| a poe ee ee ee

id:32243329 Page 11 : Pye!

pos ; C. = _ J ~ = |
: PAYRGLL AUTHORIZATION ue . , lam ° “ |
I. ‘(Please Use Typewriter ~ Ne U.S: ‘HOUSE OF. REPRESENTATIVES { SY cy erasures, corrections, or changes: |
| or. Ballpoint Pen). Washington, D.C: 20515. “on this form must be initialed: by the:
P oF Dal point. ; > oo authorizing official.)
— s|
IE aa To the Clerk ‘of: the House ‘of: Representatives: : 7 > a |
| ( |
| hereby authorize the following payroll action: ~~ i
i Employee Name (First-Middle-Last) “Effective Date |. |
Vase], . .
rn oe Employee Social Security Number - oe Type of Action |
; { te ' : ' - 7 7 . -
| . 212 548 8778 - : .| 2) Appointment ~ _ |
7 Employing Office or Committee O Salary Adjustment ae - a ae
| Sal ar % Lomeittee on ASSA83i inations Oo Termination (At close of business on effective date)
yo . , . .
| pS om ’ 8 CO
: (If type of action is an Appointment. or Salary Adjustment, complete the following information.) ~ — |
| | | - Ss 5 |
: |
bee ie . sy
| oo
[- y sO 2 . ; f ;
~~ (If Committee Employee, complete appropriate item: below.)*"~' ‘ _ °
- 1.) Standing Committee: Staff—[_] Clerical or [_] Professional. 7 x.
= Soor 2.) Special or Select Committee: Authority—H. Res. 12 o _of FEN Congress.”
| | rc a ; - |
. 3. _] Joint Committee. |
(if Employee of an Officér.of-the House, complete item below.) » - .
= Position Number. 2 If applicable, Level__ oo . Step an o y oo |
a a P ; |
| -certify.. that this quthérizotion is not “in violation, of 5. USS.C. 3110(b), prohibiting: the. employment: of 7
relatives, |
Date oo ? a December 30. a 19 #6 ‘ , _ ne ; _ : me wt . ~N ; 5 ;: J
a : ee TN ( Sigraire of Authorizing Oia |
- - Thomas U. Downiag, Chairman |
OO Se —Aomes Ae ome print name of Authorizing Official) ==SSStS=~CS 7
no — = Select Committee on Assassinations |
ne - re Tle Hf Member, Disrictond Sate) oT ~
|
- i
j

i’

All ‘appointments and:salary adjustments: for employee's under the House Classification: Act. and: for Committee=em: ~
- sployees;: except. those: ‘of-the-Committee on; Appropriations, the: ‘Committee on -the Budget, -and::the Joint Committees; ‘must “©
‘tbe approved” by. the Committee: on House Administration. - : .

root co. re . _ APPROVED: a
- y, - - -|
Office of Finance use only: ae
Office Code we |
Monthly Annuity $__________00 . -
* Copy. for Initiating Office or Committee. --- 4

W 88326 | Fa ee
MWi:37243329 Page 12 é ; woes | ; -


=

“-P0: ALL Staff Employees

MEMORANDUM ©

FROM: © Budget Officer

DATE: January, 3, 1977

| RE: | Payroll Certification

- Starting: with the | January, 1977 payroll, “the certification

to! the House Finance Office requires, among other things, the.
- syelationship, if any, of each.staff employee to any current

_ Member of Congress (those taking office January 3, 1977).

othe certification:

ome brother ~ -.- ~~... °-» father-in-law fs  . stepbrother. ©

The following are the relationships to be. included int

~ father we ee re nephew aE “prother-inJaw

mother 050 mire oo sister-in-law) 0.) |)
gon husband stepfather

daughter = Wife stepmother

sister mother-in-law = stepsister _
~» unele Ce oe gonsinelaw ... half-brother
oe aunt fo -. daughter-in-law ot Ralf-sister —
first cousin 7 Co . an : . er re

ene

- ; All staff ‘employees | are requested ‘to "complete this re ee
-form and return it to. the Budget officer. ee

- Approved

*T am,not related ~

“Richard A. Sprague

“eT-am related by the following relationship _

W 88326

1d:32243329 Page 13 ; “he

_ ‘Signat re of pmployee

er

pi Bi

eee?

